Prevalence Of Asthma In Children Research Articles

Effects of home environment on childhood asthma and allergies in subtropical South China

Association between home environment and childhood asthma and allergies among preschool children in subtropical South China is unclear. We investigated doctor-diagnosed asthma, eczema and allergic rhinitis (AR) in preschool children due to the exposure to indoor dampness and residential environment. One thousand nine hundred forty-six children (3–6 years) from 22 kindergartens in Foshan participated in this study in May 2016. Associations between home environment and childhood asthma, eczema and AR were analysed by using multivariate logistic regression model in terms of odds ratio (OR) and 95% confidence interval (CI). The prevalence of doctor-diagnosed childhood asthma, eczema and AR in Foshan was respectively 4.6%, 34.8% and 15.5%, respectively. Family member's atopy significantly increased the risk of developing asthma, eczema and AR, and the ORs were respectively 2.663 (95% CI: 1.716–4.132), 1.810 (95%CI: 1.461–2.243) and 4.194 (95%CI: 3.218–5.467). The high humidity in children's room was a significant risk to preschool children's eczema and AR. The surrounding environment was significantly associated with childhood eczema. Our study indicates that controlling the indoor dampness and allowing less natural ventilation if living near artery or industrial area are needed to reduce the risk of childhood eczema and AR in South China.

Meta-analysis of asthma prevalence of children aged 0-14 in surveillance cities of China

Objective: To understand the prevalence of asthma and its variation over time in children aged 0-14 years in China. Methods: The studies on the prevalence of asthma in children in China were systematically retrieved from China National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database (VIP) and PubMed databases. The search time was up to June 2019, and the study site was located in the asthma surveillance cities. Random effect model was used to calculate the combined prevalence of asthma and its 95% confidence interval (CI). The subgroup analysis was conducted by period, sex and region. All analyses were performed by using Stata 15.1 and R Studio software. Results: Among 2 624 articles, 67 met the eligibility criteria, and the survey time was from 1989 to 2015. A total of 1 661 076 children were involved and 40 737 asthma cases were confirmed from 26 provinces, municipalities and autonomous regions. The prevalence of asthma varied greatly among different studies, ranging from 0.5% to 9.82%. Meta-analysis showed that the combined prevalence of asthma in Chinese children aged 0-14 was 2.6% (95%CI: 2.1%-3.1%), about 3.2% (95%CI: 2.6%-3.8%) for boys and 1.9% (95%CI: 1.6%-2.3%) for girls. The subgroup analysis showed a significant variation of the prevalence over different years, genders and regions (P<0.05). The prevalence of asthma in boys was consistently higher than that of girls. The overall prevalence of asthma showed an upward trend. Before 2010, the prevalence of asthma in the eastern region was higher than that in the central and western regions. The prevalence of asthma across regions showed a significant change and the prevalence of asthma in the central region was significantly higher than that in the eastern and western regions from 2010 to 2015 (P<0.05). Conclusion: The asthma prevalence of children aged 0-14 in China is generally increasing, and the prevalence rate of boys is higher than that of girls. The prevalence rate in the central region is significantly higher than that in the eastern region from 2010 to 2015, suggesting that those regions should strengthen the early prevention and intervention of asthma and implement a sex-specific information dissemination strategy.

Role of methacholine challenge test in asthma epidemiological studies

Since asthma-like symptoms in children are common, epidemiological studies depend on subjects’ response on surveys can overestimate true prevalence of childhood asthma. Direct bronchoprovocation tests are known to have a high sensitivity and negative predictive value for current asthma. The aim of this study was to investigate the role of methacholine challenge test in asthma epidemiological studies for estimating asthma prevalence. The subjects were 5531 elementary school children from 2009-2014 in Korea. Methacholine challenge test was performed both symptomatic and a symptomatic subjects and BHR was defined as PC 20 ≤16 mg / mL. The subject considered truly asthmatic if having BHR and a positive questionnaire response. Prevalence of asthma questions (“wheezing, ever”, “wheezing current”, “asthma diagnosis, ever” “Treatment of asthma, last 12 months” “wheezing with exercise, last 12 month”), and their association with BHR was evaluated. Comorbidities were assessed with ISAAC questionnaire, skin prick tests and pulmonary function tests. Total of 4791 children (2348 male, 2443 female) aged from 7 to 12 years were included in the analysis. The overall prevalence of BHR was 15%. Rhinitis, allergic rhinitis, allergic conjunctivitis symptoms, atopy and sensitization to Dermatophagoides pteronyssinus, Dermatophagoides farina and molds were significantly associated with BHR after adjustment to age and sex (aOR; 1.86, 1.50, 1.53, 1.94, 2.09, 1.99 and 2.05) respectively. Forced expiratory flow at 25%-75% showed slightly higher sensitivity and specificity to BHR than forced expiratory volume in 1 second. Sensitivity, specificity, and accuracy of “wheezing current”, “Treatment of asthma, last 12 months”, and “wheezing with exercise, last 12 month” were (31%, 87%, 83%), (29%, 86%, 84%), and (30%, 86%, 84%), respectively. The true asthma prevalence was 5%. The Korean version of ISAAC has low sensitivity to BHR. Both subjective and objective studies are required for accurate prediction of asthma. Regarding the technical and financial limitation, performing challenge tests to the subjects who had a positive response to any asthma question could be the best combination for estimating asthma prevalence.

Impact of indoor air pollution in nursery and primary schools on childhood asthma

Poor indoor air quality in scholar environments have been frequently reported, but its impact on respiratory health in schoolchildren has not been sufficiently explored. Thus, this study aimed to evaluate the associations between children's exposure to indoor air pollution (IAP) in nursery and primary schools and childhood asthma. Multivariate models (independent and multipollutant) quantified the associations of children's exposure with asthma-related health outcomes: reported active wheezing, reported and diagnosed asthma, and lung function (reduced FEV1/FVC and reduced FEV1). A microenvironmental modelling approach estimated individual inhaled exposure to major indoor air pollutants (CO2, CO, formaldehyde, NO2, O3, TVOC, PM2.5 and PM10) in nursery and primary schools from both urban and rural sites in northern Portugal. Questionnaires and medical tests (spirometry pre- and post-bronchodilator) were used to obtain information on health outcomes and to diagnose asthma following the newest international clinical guidelines. After testing children for aeroallergen sensitisation, multinomial models estimated the effect of exposure to particulate matter on asthma in sensitised individuals. The study population were 1530 children attending nursery and primary schools, respectively 648 pre-schoolers (3–5 years old) and 882 primary school children (6–10 years old). This study found no evidence of a significant association between IAP in nursery and primary schools and the prevalence of childhood asthma. However, reported active wheezing was associated with higher NO2, and reduced FEV1 was associated with higher O3 and PM2.5, despite NO2 and O3 in schools were always below the 200 μg m−3 threshold from WHO and National legislation, respectively. Moreover, sensitised children to common aeroallergens were more likely to have asthma during childhood when exposed to particulate matter in schools. These findings support the urgent need for mitigation measures to reduce IAP in schools, reducing its burden to children's health.

Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium

BackgroundLiving in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous. ObjectiveTo investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium. MethodsAsthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6–12 and 13–18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region. ResultsConsistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15–0.17; garden, β = 0.13–0.17). The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10–0.14; garden, β = 0.07–0.09). There was no association between OAD medication sales and forest cover. ConclusionsBased on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.

Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance.

Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.

Prevalence of Childhood Asthma in Preschool Children in Qalyubiya Governorate

Prevalence of Childhood Asthma in Preschool Children in Qalyubiya Governorate

Excess free fructose, apple juice, high fructose corn syrup and childhood asthma risk \u2013 the National Children\u2019s Study

BackgroundRecent research provides consistent evidence that the unexplained doubling of childhood asthma prevalence (1980–1995), its continued climb and 2013 plateau, may be associated with the proliferation of high-fructose-corn-syrup (HFCS) in the US food supply. The HFCS used in soft drinks has been shown to contain a higher fructose-to-glucose ratio than previously thought. This coincides with a preference shift from orange to apple juice among young children. Apple juice naturally contains a high (≥2:1) fructose-to-glucose ratio. Thus, children have received high excess-free-fructose doses, the fructose type associated with fructose malabsorption. Unabsorbed excess-free-fructose in the gut may react with dietary proteins to form immunogens that bind asthma mediating receptors, and/or alter the microbiota towards a profile linked to lung disorders. Studies with longitudinal childhood data are lacking. Therefore, we tested the hypothesis that excess-free-fructose intake is associated with childhood asthma risk.MethodsCox regression models were used to analyze prospective early childhood data (12–30 months of age) from the National Children’s Study. Intake frequencies for soda/sports/fruit drinks, and 100% juices were used for analyses.ResultsGreater consumption of 100% juice, soda/sports/fruit drinks, and any combination, was associated with ~two (P = 0.001), ~ 2.5 (P = 0.001), and ~ 3.5 times (P < 0.0001) higher asthma incidence.ConclusionsGiven these results, prior research and case-study evidence, it is reasonable to suggest that the two-fold higher asthma risk associated with 100% juice consumption is due to apple juice’s high fructose-to-glucose ratio, and that the ~ 2.5/~ 3.5 times higher risk associated with soda/sports/fruit drinks intake is with the excess-free-fructose in HFCS.

Effectiveness of dental caries prevention in children with bronchial asthma

Asthma is one of the common diseases in the pediatric population in children, the prevalence of asthma in children in the world is 5 – 10 %. According to the literature, the dental caries in children with asthma is 68. 45 – 88. 1%. The development of dental caries in children with asthma is affected by changes, which are in the body of children, as well as long-term drug treatment.Objective. To evaluate the effectiveness of preventive measures in children with asthma.Material and methods. Under our supervision, which lasted for two years, there were 144 12-year-old children suffered from asthma and were treated in the pulmonary allergy department of the children's regional hospital. A set of measures was developed for the prevention of dental caries for children with I-II and III-IV severity of asthma. Assessment of the effectiveness of the complex of preventive measures was carried out after 6, 12, 24 months according to the following criteria: caries intensity (DMF), reduction of the increase in the dental caries intensity, enamel resistance by TER.Results. The improvement of the following indicators was found for 2 years of our observation: decrease in the increase of caries intensity in children with III-IV compared with I-II severity of asthma; improving of oral hygiene (according to the Green-Vermillion index); increase of enamel resistance by TER test. The reduction of the increase in caries intensity in children with asthma constitutes 46.94% in children with I-II and 51.02% with III-IV severity of asthma.Conclusions. The analysis of the results of the children’s examination for two years of application of the developed set of measures for dental caries prevention shows that the implemented measures are effective for use in children depending on the severity of asthma.

The disease burden of childhood asthma in China: a systematic review and meta-analysis.

BackgroundIn China, childhood asthma prevalence showed a remarkable increase in the past decades. An updated epidemiological assessment of childhood asthma in China with a focus on prevalence and time trends is required.MethodsWe systematically searched three main Chinese databases and one English database to identify epidemiological studies of the prevalence of childhood asthma in China. Asthma cases were defined according to one of the five sets of Chinese diagnostic criteria which were established by the Children Respiratory Disease Group. We estimated age- and sex-specific prevalence of asthma using a multilevel mixed-effects logistic regression. We presented the time trends of asthma prevalence between 1990 and 2020 by age, sex and setting (urban vs rural), and also estimated the number of children affected by asthma in 2010.ResultsIn 1990, the prevalence of asthma ranged from 0.13% (95% confidence interval (CI) = 0.10-0.20) in rural girls aged 14 years to 1.34% (95% CI = 1.11-1.67) in urban boys aged five years. In 2010, the overall prevalence of asthma in Chinese children aged 0-14 years was 2.12% (95% CI = 1.83-2.51), corresponding to 5.16 million children living with asthma. Children aged 5-9 years were with the highest prevalence estimate of 2.65% (95% CI = 2.31-3.12) and those aged 10-14 years were with the lowest (1.48%, 95% CI = 1.26-1.78). In 2020, it is expected that this disparity will continue, with the prevalence of asthma being at the lowest level among rural girls aged 14 years (1.11%, 95% CI = 0.82-1.54) and at the highest level among urban boys aged four years (10.27%, 95% CI = 8.61-12.18). Over the 30 years (1990-2020), the prevalence of asthma in children aged 0-14 years has increased in both sexes and settings, which was consistently the lowest in rural girls and the highest in urban boys.ConclusionsThis study shows that childhood asthma has been increasingly prevalent in China. Asthma is more frequent in boys and in rural areas. The detailed and systematic estimates of asthma prevalence in this study constitute the best currently available basis for policymaking, planning, and allocation of health and welfare resources related to the burden of childhood asthma in China.

Whole-Genome Sequencing Identifies Novel Functional Loci Associated with Lung Function in Puerto Rican Youth.

Rationale: Puerto Ricans have the highest childhood asthma prevalence in the United States (23.6%); however, the etiology is uncertain.Objectives: In this study, we sought to uncover the genetic architecture of lung function in Puerto Rican youth with and without asthma who were recruited from the island (n = 836).Methods: We used admixture-mapping and whole-genome sequencing data to discover genomic regions associated with lung function. Functional roles of the prioritized candidate SNPs were examined with chromatin immunoprecipitation sequencing, RNA sequencing, and expression quantitative trait loci data.Measurements and Main Results: We discovered a genomic region at 1q32 that was significantly associated with a 0.12-L decrease in the lung volume of exhaled air (95% confidence interval, -0.17 to -0.07; P = 6.62 × 10-8) with each allele of African ancestry. Within this region, two SNPs were expression quantitative trait loci of TMEM9 in nasal airway epithelial cells and MROH3P in esophagus mucosa. The minor alleles of these SNPs were associated with significantly decreased lung function and decreased TMEM9 gene expression. Another admixture-mapping peak was observed on chromosome 5q35.1, indicating that each Native American ancestry allele was associated with a 0.15-L increase in lung function (95% confidence interval, 0.08-0.21; P = 5.03 × 10-6). The region-based association tests identified four suggestive windows that harbored candidate rare variants associated with lung function.Conclusions: We identified common and rare genetic variants that may play a critical role in lung function among Puerto Rican youth. We independently validated an inflammatory pathway that could potentially be used to develop more targeted treatments and interventions for patients with asthma.

ATMOSPHERIC POLLUTANTS AND PREVALENCE OF ASTHMA AMONG CHILDREN: A REVIEW

Asthma is a common and severe pathology in children with a potential for life-threatening complications. The development of asthma in childhood is determined by a complex interplay between various aetiological factors. Air pollution is one of the most important environmental factors contributing to the development of asthma in children. This review summarizes the available evidence on the impact of air pollution on the prevalence of asthma among children in different countries. The increase in the prevalence of asthma in childhood correlates with the concentrations of particulate matter

The association between neuraxial anesthesia and the development of childhood asthma – a secondary analysis of the newborn epigenetics study cohort

Objectives Childhood asthma is a common chronic illness that has been associated with mode of delivery. However, the effect of cesarean delivery alone does not fully account for the increased prevalence of childhood asthma. We tested the hypothesis that neuraxial anesthesia used for labor analgesia and cesarean delivery alters the risk of developing childhood asthma. Methods Within the Newborn Epigenetics Study birth cohort, 196 mother and child pairs with entries in the electronic anesthesia records were included. From these records, data on maternal anesthesia type, duration of exposure, and drugs administered peripartum were abstracted and combined with questionnaire-derived prenatal risk factors and medical records and questionnaire-derived asthma diagnosis data in children. Logistic regression models were used to evaluate associations between type of anesthesia, duration of anesthesia, and the development of asthma in males and females. Results We found that longer duration of epidural anesthesia was associated with a lower risk of asthma in male children (OR = 0.80; 95% CI = 0.66–0.95) for each hour of epidural exposure. Additionally, a unit increase in the composite dose of local anesthetics and opioid analgesics administered via the spinal route was associated with a lower risk of asthma in both male (OR = 0.59, 95% CI = 0.36–0.96) and female children (OR 0.26, 95% CI 0.09–0.82). Conclusion Our data suggest that peripartum exposure to neuraxial anesthesia may reduce the risk of childhood asthma primarily in males. Larger human studies and model systems with longer follow-up are required to elucidate these findings.

Breastfeeding, Serum Level of Hemoglobin and Ferritin Associated with the Risk of Asthma in Children: A Case-Control Study

Background: During recent decades, there has been a dramatic increase in the prevalence of asthma in children. There is low-grade quality evidence that breastfeeding and anemia are associated with a reduced risk of asthma in children up to 5 years of age. Objectives: Regarding the high prevalence of anemia and asthma in Iranian children, we aimed to evaluate the risk factors for asthma in children. Methods: The present case-control study examined 110 children (55 cases and 55 controls) aged 3 to 12, admitted to Shahroud educational hospitals from March 2017 to February 2018. The children diagnosed based on the Global Initiative for Asthma criteria, by a specialist physician, were selected as the case group and those admitted to other hospital wards for diseases (such as orthopedic and nephrology), other than respiratory problems were selected as the control group. Multivariable logistic regression was used to find asthma risk factors. P < 0.05 was considered statistically significant. Results: Of 110 children, 63 (57.3) were boy and mean (± standard deviation (SD)) age of the participants was 7.23 (± 4.17) years and mean weight was 29.6 (± 21.6) kg. Most of the children (76.4) were fed by breast milk during infancy. Mean (± SD) Hb in the case group was 10.4 (± 2.5) g/dL and in the control group was 11.5 (± 2.3) g/dL (P = 0.01). The prevalence of anemia was 72.7 and 50.9 in the case and control group, respectively (P < 0.001). After controlling for potential confounders, breastfeeding (OR breast milk only vs. formula only = 2.23, P = 0.01), serum level of hemoglobin (OR = 0.13, P = 0.002) and ferritin (OR = 0.32, P = 0.04) were significantly associated with the risk of asthma. Conclusions: Our study found the role of low duration of breastfeeding and ferritin deficiency as a risk factor for development of asthma in children. This finding emphasizes that iron supplementation along with breastfeeding in childhood may prevent asthma and hence reduce the children’s mortality and morbidity rates associated with asthma. © 2020, Author(s).

Why Do Intrauterine Exposure to Air Pollution and Cigarette Smoke Increase the Risk of Asthma?

The prevalence of childhood asthma is increasing worldwide and increased in utero exposure to environmental toxicants may play a major role. As current asthma treatments are not curative, understanding the mechanisms underlying the etiology of asthma will allow better preventative strategies to be developed. This review focuses on the current understanding of how in utero exposure to environmental factors increases the risk of developing asthma in children. Epidemiological studies show that maternal smoking and particulate matter exposure during pregnancy are prominent risk factors for the development of childhood asthma. We discuss the changes in the developing fetus due to reduced oxygen and nutrient delivery affected by intrauterine environmental change. This leads to fetal underdevelopment and abnormal lung structure. Concurrently an altered immune response and aberrant epithelial and mesenchymal cellular function occur possibly due to epigenetic reprograming. The sequelae of these early life events are airway remodeling, airway hyperresponsiveness, and inflammation, the hallmark features of asthma. In summary, exposure to inhaled oxidants such as cigarette smoking or particulate matter increases the risk of childhood asthma and involves multiple mechanisms including impaired fetal lung development (structural changes), endocrine disorders, abnormal immune responses, and epigenetic modifications. These make it challenging to reduce the risk of asthma, but knowledge of the mechanisms can still help to develop personalized medicines.

Use of the complex of models of regression for analysis of the factors that determine the severity of bronchial asthma

Background: According to an International Study of Asthma and Allergies in Childhood (ISAAC), the prevalence of asthma in children of 6-7 years old has increased by 10%, and at the age of 13-14 years by 16% over the last decade. Determining the factors that are keys to the occurrence of the disease and its severity is important in explaining the pathogenesis of bronchial asthma. Methods: Analyzed 142 indicators of clinical and paraclinical examination of 70 children with asthma. To select factors that could be significant in the formation of severe asthma, applied the method of logistic regression with step-by-step inclusion of predictors. Both quantitative and qualitative characteristics were selected. Each qualitative attribute was coded “1” if the child had this characteristic, or “0” if this characteristic had not been established. The formation of a severe asthma course was accepted according to (1) and the absence of a severe asthma flow formation as (0). Results: Analyzed the model of paired regression, the boundary value of thymic stromal lymphopoietin was established, exceeding which indicates the high probability of the presence of severe bronchial asthma. Increasing the value of thymic stromal lymphopoietin by 10 pg/mL suggests an increase in the likelihood of severe asthma by 10%. Conclusions: A complex of steam regression models has been developed to determine the factors characterizing the severity of bronchial asthma. The risk of developing severe bronchial asthma in children has been determined and 15 factors have been identified that affect severe asthma.

Asthma Management in Qatar: Environmental Challenges and Recommendations

Asthma has become the most common respiratory problem in the world. A number of environmental factors that trigger asthma have been cited. These include indoor and outdoor pollutants, allergens, and infections. In Qatar, however, poor air quality seems to be the most common trigger of asthma. With the second highest prevalence of childhood asthma in the Gulf region (19.8%), the factors that contribute to this poor air quality include natural sources, microbial communities, phytoplankton blooms, anthropogenic sources, vehicular emissions, industrial emissions, and construction activity. With the increasing changes to the climate and the ongoing development of the country, Qatar is facing a growing problem. As such, investigation into the air quality is required. In addition, the development of national asthma control guidelines and education and training programs is essential in order to combat this growing issue and lower the prevalence of asthma in the country.

Association between body mass index and asthma severity in Arab pediatric population: A retrospective study.

Increased body mass index (BMI) has been associated with an increased prevalence of asthma in children, however the association between BMI status and asthma severity has been less well defined. The aim of this study was to describe the association between childhood obesity and asthma severity, frequency of hospital and emergency department visits as well as pattern of aeroallergen sensitization. A retrospective study was conducted at pediatric outpatient clinics in University Hospital Sharjah. All consecutive patients aged 6 years and above, with confirmed diagnosis of asthma visiting the outpatient pediatric clinics during 2018 were included in this study. Sources of information were the patient’s medical file, laboratory data, pharmacy data, as well as reports from the pediatric in charge. This study included 164 children with asthma. 63% of asthma patients were male. The vast majority of patients were from Arab ethnicities (n = 154, 94%), majority had mild asthmatic conditions (n = 133, 81%), and one-third were either overweight or obese (n = 52, 32%). Overweight or obese asthmatic children with BMI percentile of equal or more than 85% was associated with more asthma severity (odds ratio [OR]: 3.27, 95% confidence interval [CI]: 1.42–7.54; P = 0.005), as well as more frequent asthma related hospital visits (OR: 2.53, 95% CI: 1.22–5.26; P = 0.013). Overweight asthmatic children with BMI between the 85th and 94th percentiles and obese asthmatic children with BMI equal to or greater than 95th percentile are associated with more severe asthma phenotype and more frequent hospital and emergency department visits.

Asthma.

Asthma is the most common chronic respiratory disease of childhood, a leading cause of emergency department visits, and 1 of the top 3 indications for hospitalization in children. Despite advances in the management of pediatric asthma, significant disparities in care and outcomes persist. To bridge these gaps, we must embrace the concept of asthma care across the continuum and extend our reach beyond the immediate patient-provider visit.After completing this article, readers should be able to:Asthma is defined by episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants. It is a complex, multifactorial, and immune-mediated process that presents with various clinical phenotypes.Despite novel treatments and guideline-based care, asthma remains a significant public health problem. Medical care, missed school, and missed work related to asthma continue to burden our communities, costing more than $80 billion each year. (1) Furthermore, asthma disproportionately affects minorities and socioeconomically disadvantaged children. (2) Black children have the highest asthma morbidity and mortality rates of any US group, with twice the emergency department (ED) visit/hospitalization rate and 9 times the mortality rate as white children. (3)(4)(5)In 2012, the President’s Task Force on Environmental Health Risks and Safety Risks to Children commissioned a cabinet-level, multiagency group to address overall asthma morbidity and its racial and ethnic disparities. (6) The group chose 4 integrated strategies.Asthma affects 1 in 12 US children aged 0 through 17 years. (3) After decades of increases, the prevalence of asthma in this group plateaued between 2010 and 2012, (2) decreased in 2013 from 9.3% in 2012 to 8.3%, and remained stable through 2016. (2)(3) In contrast, pediatric asthma prevalence in black children increased between 2001 and 2009, leveling off by 2013. (2) In 2016, asthma prevalence in black children rose sharply to 15.7% (a 2.3% increase from 2014 and 2015), twice that of white children. (3) This rate surpassed that of Puerto Rican children, who previously had the highest prevalence of asthma of all US children. (3) The prevalence of asthma in children in poverty did not decrease between 2001 and 2013 and remained high in 2016 (10.5%). (2)(3)Asthma exacerbation is a leading cause of (ED) visits (7) and 1 of the top 3 indications for hospitalization in children. (8) Comparing asthma outcomes between subgroups, an at-risk rate (ARR) is preferred over the traditional population-based rate (PBR). (9) An ARR is the number of children with the outcome (eg, asthma hospitalization or death) divided by the total number of children at risk for that outcome (those with asthma). Conversely, a PBR is the number of children with the asthma outcome divided by the total population. PBRs measure the overall burden of disease in a particular population or subgroup, whereas an ARR accounts for differences in prevalence between subgroups to describe disparities.(4) Between 2001 and 2010, ARRs for black and white children revealed a decrease in racial disparities for ED visit and hospitalization rates and no change in death rate due to asthma. (4) It is important to note, however, that ARRs do not account for differences in underlying asthma severity. A 2013 analysis of hospitalizations for chronic conditions in the Pediatric Health Information System database found that black children had the highest asthma readmission rate (21.4%) of any race or ethnicity. (10) Finally, because ARRs rely on prevalence estimates, any undercounting of

P350 PORTABLE DIAGNOSTIC HEALTH SENSOR DEVICE- A NOVEL METHOD TO MONITOR ASTHMA IN CHILDREN

Despite high prevalence of asthma in children, there is a lack of non-invasive technology to monitor asthma. Our lab designed a non-invasive breath diagnostic tool that measures exhaled breath metabolites in real time and longitudinally. We tested the prototype device in collecting exhaled breath condensate, and seek to improve the device’s future design by surveying participants for their preferences in utilizing such a device.